Background: A survey of literature revealed that although a great deal of research has been carried out about stress and coping mechanisms internationally, little has been written about stress and coping mechanisms among Nurses in Federal medical center Umuahia.

Objective: The objectives of this study were to identify the possible causes and frequency of stress experienced by Nurses working in governmental and non-governmental hospitals, and to assess the most common ways of coping mechanisms.

Methods: A cross-sectional descriptive study was conducted. Nursing Stress Scale (NSS) and three subscales of Ways of Coping Checklist (WCC) were used to assess stress and coping mechanisms among Nurses.

Results: Data revealed that nurses were stressed. According to NSS, the greatest perceived sources of stress appeared to be “workload” (mean=2.93) followed by “conflict with other nurses” (mean=2.63) and “emotional issues related to death and dying” (mean= 2.56). Nurses in non- governmental hospitals have significantly higher “conflict with other nurses” stress than those in governmental hospitals: 2.77 versus 2.55; (p=<0.01). Nurses with longer years of service have significantly higher “Uncertainty concerning treatment” stress than nurses with shorter years of service: 2.41 versus 2.2; (p=0.01). According to the ways of coping mechanism, nurses seemed to be resorting more to “confronting coping” (mean=2.41) while “escape avoidance” was the least coping strategy employed (mean=2. 04). Male nurses seem to resort significantly more to “confronting coping” than female nurses: 2.49 versus 2.29; (p=0.02). Nurses with long years of service seem to resort significantly more to “Distancing” than nurses with shorter years of service: 2.3 versus 2.17; (p=0.03).

Conclusion: Stress among nurses is serious. Providing more nursing staff and decreasing non-nursing jobs might help to decrease nursing stress, according to coping mechanisms nurses seem to employ confronting coping strategy and this is not a healthy style some time, providing more coping strategy by mental health nurses via programs in the hospital will help nurses to choose the best coping strategy for each one.

In the 1930s, Hans Selye, a medical doctor had described stress as a strain on living organisms. Selye’s concept of stress has been used to describe the body’s mobilization on dealing with a challenge or threat (Griffin 1990). Dr. Selye, defined stress as “the body’s non-specific response to any demand”. He classified stress into two categories, each with two variations: distress (harmful or disease-producing stress) and eustress (beneficial stress) (Drafke and Kossen 2002). In his study of stress, Selye introduced General Adaptation Syndrome model, which consisted of 3 stages; alarm resistance and exhaustion. This model brings out a distinction between short- and long-term effects of stress on the body (Marshall and Cooper 2019).

Besides the physiologically oriented approach to stress represented by the classic General Adaption Syndrome model, which still remains a vital dimension of modern stress research and stress management, attention is also being given to the psychological (for example, mood changes, negative emotions, feeling of helplessness, etc) and the behavioral (for example, directly confronting the stressors, obtaining information about the stressors, etc) dimension of stress (Luthans 1998). All three dimensions (physiological, psychological, and behavioral) are important to the understanding of job stress and coping mechanism in modern organizations. Stress is an unavoidable feature of modern living impact of dynamic and uncertain environment characterized by restructuring, reengineering, layoff and downsizing which threatened one’s personal security of employment (Huber, 1996:561). Generally, stress is always thought of in negative terms. That is, stress is perceived as something bad, annoying, threatening and not wanted (Mckenna 1994). For example, words or phrases such as depression, feeling out of control, overworked, migraine or headache, time pressure, anxiety, cannot sleep, are commonly used to express what stress means to us personally (Sutherland and Cooper 2000). It is one of those words that everybody knows the meaning of but no-one can define it (Woodham 1995). As a result, it is vital to give attention to what stress is not about in today’s organization. As pointed out by Luthans (1998) three major misconceptions about stress are as follows:

1. Stress is not simply anxiety. Anxiety operates solely in the emotional and psychological sphere, whereas stress operates both and also in the physiological sphere. Thus, stress may be accompanied by anxiety, but the two should not be equated.

2. Stress is not simply nervous tension. Like anxiety, nervous tension may result from stress, but the two are not the same. Unconscious people have exhibited stress and some people may keep it “bottle up” and not reveal it through nervous tension.

3. Stress is not necessarily something damaging, bad or to be avoided. Stress is inevitable. Stress is not damaging or bad and is something people should seek out rather than avoid. The key is how the person handles stress. Understanding the definition of stress, especially stress in an organization is important because it can have both positive and negative effects and also learning about how to cope with job stress. Stress can be illustrated as a non-specific state that is composed of a variety of induced changes in the human biological system (Rice 2000). For this reason, stress often creates a nonspecific response, which means that certain emotional, physical and cognitive responses occur automatically (Hellriegel 2016). In other words, stress is described as a personal response and a phenomenon that occurs in a body as a reaction to the stimulus of a stressor (Huber 1996). Stress is the subjective feeling produced by events that are uncontrollable or threatening, constant stress brings about changes in the balance of hormones in the body which may lead to the situation or thought that makes us feel frustrated, angry, nervous, or anxious (Randy JL 2008). Stress is particularly acute among people who work in the ‘helping professions’ (Siegrist 2010) and can have devastating effects on healthcare staff and their working environments (Lambert and Yamase 2003). A previous study about health workers defined stress as a result of emotional worries, lack of control in highly-demanding work situations, feelings of exertion, fatigue and changes in health (Lautert, Chaves et al. 1999). The National Institute of Occupational Safety and Health defined work-related stress, also called professional or occupational stress, as a consequence of the disequilibrium between work demands and workers’ skills/resources or needs or, also, work-related stress represents a pattern of an emotional, cognitive, behavioral and physiological reaction to harmful and adverse components of the work context (European Commission 1999). Risk factors for job stress include: i) role ambiguity; ii) role conflict; iii) insufficient tasks attributed; iv) responsibility for people; v) insecurity at work, aspects related to career evolution, feeling of injustice regarding one’s own salary and delayed promotions; vi) lack of participation in work- related decision making; vii) deficient interpersonal relations with superiors, subordinates or colleagues; ix) exposure to violence at work; viii) home/work interface and ix) shift and night work (Sacadura-Leite E 2007). In the health sector, occupational stress is a highly present aspect and, among all health professionals, nurses are the most exposed (Vaz Serra 2002). In the hospital context, intensive care units (ICU) are particularly stressful environments, serving for care delivery to critical patients, who require permanent and specialized medical and nursing care; they are characterized by demanding routines, sophisticated and noisy equipment, mostly without natural light and high chances of death and pain (Cavalheiro, Moura Junior et al. 2008). Also, health professionals’ work conditions, motivation and wellbeing have been relegated to the background (Martins 2009). A previous study of nursing stress has found positive relationships between work stress and subjective perceptions of mental distress, and high incidences of stress-related `burnout' and emotional disorders (Cushway 1992). Burnout has been defined as a syndrome that consists of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach 2019). Burnout is viewed as an affective reaction to ongoing stress whose core content is the gradual depletion over time of individuals’ intrinsic energetic resources, including the expression of emotional exhaustion, physical fatigue, and cognitive weariness (Shirom 2019). It has been found that in order to cope with these constraints, nurses may be using avoidance and escape forms of coping (Marshall 2010). The transactional model argues that stressors, coping and emotional reactions need to be considered jointly in explaining the stress coping process because they are interdependent (Folkman 2019). Researchers described stress as a dynamic and reciprocal relationship between the person and the environment (Folkman 2014). Stress is only experienced when situations are appraised as exceed one's resources, Thus, being given extra responsibilities at work might be viewed as threatening to one person while another person may appraise the situation as a challenge (Folkman 2014). Coping is the process of managing demands that are appraised as taxing or exceeding the resources of the person (Shelley 2003). Thus, coping is not a one-time action that someone takes; rather, it is a set of responses, occurring over time, by which the environment and the person influence each other’s (Andrew 2009). How a person copes can influence the degree, duration, and frequency of a stressful event and it’s important for a person to learn how to recognize when his stress levels are out of control (Randy JL 2008). One cannot completely eliminate stress from one's life, but can control how much it affects, one may feel like the stress in life is out of control, but can always control the way one responds (Randy JL 2008). Coping has been viewed as a stabilizing factor that may assist individuals in maintaining psychosocial adaptation during stressful events, the process of coping is a very complex response that occurs when an individual attempts to remove stress or a perceived threat from the environment (Lazarus and Folkman 2014). Thus, the actual reaction to an environmental event may be as important as the event itself. Coping responses can be described as positive or negative and as reactive (i.e. reacting to an individual's own thoughts and feelings), or active (i.e. dealing with actual stressful situations or events) (Lazarus and Folkman 2014). Active or reactive coping responses can be positive or negative, depending on the situation and the content of the response (Lazarus and Folkman 2014).

1.2 Statement of problem
Stress is recognized as an inherent feature of the work life of nurses, and growing evidence suggest that it may be increasing in severity. Work- related stress has been implicated as a major contributing factor to growing job dissatisfaction, rapid turnover, and high attrition rates among nurses. It was found that job stress impacts not only on nurses’ health but also their abilities to cope with job demands. This will seriously impair the provision of quality care and the efficacy of health service delivery (Lee 2003).

A survey of literature revealed that although a great deal of research has been carried out about stress and coping about nurses internationally, however, to the best of our knowledge, little has been written about stress among Nurses in Federal medical center Umuahia. Given that the international hospital settings and the provision of health services are different than those in Nigeria, it would not be appropriate to use the results of previous international studies to explain stress and coping among Nurses. This investigation is aimed to identify causes and frequency of stress, and coping strategies used, among Nurses in Federal medical center Umuahia. It also sought to answer the following question:

1. What are the occupational stressors experienced by nurses in their area of assignment at the clinical area in terms of?

a. Workload. b. Uncertainty concerning treatment. c. Problems with nurse managers. d. Inadequate emotional preparation. e. Conflict with physician.

f. Patients and their families

1.3 Aim of the study
To determine the possible causes of stress and coping mechanism between the nurses working in hospitals in Umuahia.

1.4 Objectives of the study
In specific, the current study aimed:

1. To determine the stressors that Nurses commonly faced in their work in Umuahia.

2. To determine the coping mechanisms that Nurses used in their work in Umuahia.

3. To assess the relationships between nurses’ stressors and the coping mechanism they used.

4. To assess the relationship between the dependent and independent variables.

1.5 Research question
What are the stressing factors among nurses in Federal medical center Umuahia in Umuahia?

1.6 Significance of the study
1. This study will give baseline data and information to explain the prevalence of stress and coping mechanism among nurses in governmental and non-governmental hospitals in Nigeria.

2. The results of this study will be useful in the formulation of recommendation to address stress among Nurses in Federal medical center Umuahia.

3. Identification of stress is very significant to identify strategies used in coping with stress.

1.7 Limitations
The following are considered limitations to our study:

1. The response rate is low.

2. The study was confined to Umuahia hospitals while other hospitals were not included.

3. Several other variables were not included in the coping questionnaire. Such as praying, acceptance, sharing hobbies with others, and schedule physical activities.

4. The association of stress with other demographic variables like marital status and income and education were not studied. Other variables such as work unit were not included in the study.

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